34. Non-regenerative anaemias Flashcards

1
Q

Non- Regenerative Anaemias?

A

Anaemias with a lack of regenerative response (whereby new RBC

production is insufficient for the demand)

Normal reticulocyte (immature RBCs) count:

§ Dog: 60-80 x 109 cells/l

§ Cat: 15-42 x 109 cells/l

During blood loss, this number should be ~3× higher

During haemolysis, this number should be ~7× higher

Polychromasia: When there is an ↑ of intensely stained (likely

immature) RBCs

It takes ~4 days for RBCs to mature, so this is the length of time

needed for the bone marrow to respond to the anaemia

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2
Q

Causes of Non- Regenerative Anaemias?

A

Causes Of Non-Regenerative Anaemias

DRUGS/TOXINS

Chemotherapy:

§ 5 days of neutropenia

§ 2 weeks of thrombocytopenia

§ ~1 month of anaemia

§ Damage is often reversible

Oestrogen:

§ Dose-dependent; Poor prognosis

§ Either exogenous or endogenous (neoplasia)

Other drugs:

§ Anti-inflammatories: Phenylbutazone

§ Antibiotics: Trimethoprim

§ Anticonvulsants: Phenobarbital

§ Antiparasitics: Fenbendazole

PATHOGENS

§ Parvovirus § Histoplasma spp.

§ Rickettsia spp. § Leishmania spp.

§ Ehrlicia canis § Cryptococcus spp.

§ FIV § Feline panleukopenia

PRIMARY BM SUPRESSION

§ Pure red cell aplasia (reticulocyte precursor destruction)

§ Aplastic anaemia (hypoplastic BM replaced by fat)

§ BM necrosis; BM fibrosis

§ BM tumour

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3
Q

Non- Regenerative Anaemia Diseases?

A

Non-Regenerative Anaemia Diseases

PURE RED CELL APLASIA

Immune mediated intravascular peracute haemolysis (nonregenerative immune mediated haemolytic anaemia)

If it remains non-regenerative for >5 days, the immune system is

targeting erythroid precursor cells in the BM

Predisposed: Young/middle-aged; Neutered females

Diagnosis → BM biopsy:

§ Dysmyelopoesis § Fibrosis

§ Haemorrhage § Necrosis

Treatment: See “Immune mediated haemolytic anaemia” in topic 32

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4
Q

Deficiency Anaemias/ Refractory Anaemias?

A

DEFICIENCY ANAEMIAS / REFRACTORY ANAEMIAS

Anaemias not related to the bone marrow

Iron deficiency anaemia
§ Chronic blood loss
§ Blood sucking parasites
§ Chronic GI bleeding (ulcer; tumour)
§ Chronic cystitis
Vitamin B12 deficiency
Anaemia perniciosa
§ Chronic GIT disease → IBD
§ EPI
§ Hereditary receptor defect: Giant Schnauzer; Beagle
Chronic kidney disease → Erythropoietin loss
Erythropoietin is produced in the renal cortex
§ Treatment: Recombinant human erythropoietin & iron
§ During end-stage kidney failure, azotaemia may have an
additional detrimental effect to the RBCs, worsening the
animal’s condition

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5
Q

Anaemia of chronic disease?

A

ANAEMIA OF CHRONIC DISEASE

Lack of hormones

§ Hypothyroidism (diagnose with T4/TSH)

§ Addison’s disease (diagnose with ACTH-stim.)

Portosystemic shunt

Inflammation → Cytokine release → ↑ Hepcidin release → ↓

Ferritin → ↓ Fe availability

Causes:

§ Chronic inflammatory disease (IBD)

§ Acute inflammatory disease (pyometra; sepsis)

§ Chronic kidney disease

§ Neoplasia

Diagnosis: ↓ Fe; ↓Fe-binding capacity; ↑ CRP (C-reactive

protein)

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6
Q

Myelodysplastic syndromes?

A

MYELODYSPLASTIC SYNDROMES

Group of cancers; Immature RBCs fail to mature

Clinical signs: Weakness; Exercise intolerance; Fever; Haemorrhage

Lab. D: Non-regenerative; Panleukopenia; Thrombocytopaenia

Diagnosis: BM biopsy → Dyserythropoesis; ↑ Myeloblasts

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7
Q

Acute Lymphoblastic Anaemia?

A

ACUTE LYMPHOBLASTIC ANAEMIA

Proliferation of immature lymphoblasts

Predisposed: Middle/old-aged > Young

Clinical signs

§ Lethargy

§ Weight loss

§ Intermittent fever

§ Hepatosplenomegaly

§ Abdominal pain

Lab. D: Anaemia; Leukopenia; Ø Lymphoblasts in peripheral blood

Diagnosis: BM biopsy → Lymphoblast proliferation (30%

lymphoblasts)

Differential diagnosis: Lymphoma stage V

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8
Q

Chronic Lymphoblastic anaemia?

A

CHRONIC LYMPHOBLASTIC ANAEMIA

Proliferation of mature lymphocytes (CD8 & T-cells)

Predisposed: Old > Young

Clinical signs

§ Hepatosplenomegaly § Fever

§ Intermittent lameness § PU/PD

§ Mild lymphadenomegaly § Haemorrhages

Lab. D: Normocytic, normochromic non-regenerative anaemia;

Lymphocytosis; Neutropenia
Treatment: Prednisolone + Chlorambucil

Treatment of non-regenerative anaemia

§ Treat the underlying cause

§ Blood transfusion

§ Anaemia: Give packed red blood cells

§ Thrombocytopaenia: Fresh whole blood;

Packed RBCs + Platelet rich plasma

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